Provider Demographics
NPI:1801831219
Name:DEVGAN, UDAY (MD)
Entity Type:Individual
Prefix:
First Name:UDAY
Middle Name:
Last Name:DEVGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 WILSHIRE BLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-696-0330
Mailing Address - Fax:310-388-3028
Practice Address - Street 1:11600 WILSHIRE BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-696-0330
Practice Address - Fax:310-388-3028
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA65426207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A654260Medicaid
CAH21400Medicare UPIN
CA00A654260Medicaid